The dangers of delaying a glue ear operation

by JENNY HOPE, Daily Mail

Thousands of children with hearing difficulties have spent years doing badly at school because doctors have failed to recommend vital ear surgery, specialists claim.

New research shows the number of referrals to hospital for treatment of glue ear - a chronic condition that is the biggest single cause of hearing loss in children - has plummeted in the past few years.

It also shows a sharp drop in the number of surgical operations to insert ventilation tubes (grommets) in the eardrum to relieve internal pressure and restore hearing.

Experts blame the introduction of a policy of 'watchful waiting' by GPs, who are not referring children to hospital because glue ear sometimes gets better without treatment.

And when an alert junior school teacher suspected that eight-year-old Ralph Whitby's slow progress in class could be due to hearing problems, Ralph's mother Janet, 46, from North London, was dismayed to find there would be a long wait to get help even though he was lagging behind classmates in reading and speech.

Professor Mark Haggard, chief adviser to the charity Defeating Deafness, carried out a study showing that children who are not treated before going to school are condemned to a lifetime of educational problems.

The study of more than 1,000 children born in New Zealand in the early Seventies suggests early glue ear affects behaviour, IQ and reading, into late teens.

It found that compared with 'normal' children, those with a history of glue ear had lower IQ up to the age of 13, more hyperactive and inattentive behaviour up to 15, and reduced reading ability up to 18.

It concluded that 'early middle ear disease history appears to have a deleterious effect on reading ability, verbal IQ and behaviour problems'.

Professor Haggard, director of the Medical Research Council's Institute of Hearing Research, said the right treatment for established glue ear is surgery, particularly for children over the age of three-and-a-half.

He adds: 'The policy of watchful waiting has gone too far. There are no firm guidelines about when to stop watching and do something.

'If you watch too long, with the accumulation of delays which inevitably occur in the hard-pressed NHS, it means many children don't get treatment and so have continuing problems and are disadvantaged by the time they come to school.'

Glue ear, medically known as otitis media with effusion (OME), affects more than 20per cent of two-year-olds and 15 per cent of five-year-olds in winter.

GP referrals of children with the condition to ear, nose and throat specialists fell by more than half from 1994 to 1998.

And the quarterly rate of grommet insertions in England fell from 2.1 per thousand children in 1992 to less than one per thousand in 1999.

Janet Whitby says: 'When it became clear we were going to have to wait months before seeing a consultant we were very concerned because Ralph was being affected in so many ways: playing sport, socialising and in the classroom.

'He was also very tired because of the effort of concentrating so hard to hear.' The GP was sympathetic but it still took more than six weeks to get a hearing test, and more time was lost waiting for the results.

'We were told it would take several months to see a consultant so we decided to go privately.' Last November Ralph had grommets fitted at a private London hospital.

'The difference was amazing, says Mrs Whitby. 'The operation takes about 20 minutes and he had a general anaesthetic. When he came round, a phone was ringing down the hall and he tried to pick up the one next to the bed, thinking it was ringing because he'd never heard it so clearly before.

'We feel he's doing really well and making progress at school.'

Mrs Whitby and her engineer husband, who have four children, regret the wasted time. And when she found her twoyear-old son Chad was also having speech problems, she insisted on a hearing test.

'He needed grommets as well - glue ear is a bigger problem in boys - and we're pleased to have made the discovery at a much earlier stage.'

Professor Tony Wright, director of the Institute of Laryngology & Otology at London's Royal National Throat, Nose and Ear Hospital, says: 'Studies show that the presence of a significant hearing loss in young children affects behaviour, the acquisition of skills, and speech and language development.

'The longer a child waits for surgery, the longer these problems persist and the greater the risk of structural damage to the ear, which can lead to long-term deafness.'

Deafeating Deafness chief executive Vivienne Michael said 'Glue ear can be difficult to identify, and many younger children get better relatively quickly without the need for treatment. But there is clear evidence that children with these risk factors are prone to hearing loss.

'They are likely to benefit from surgery and should not be held up too long in primary care.' She said parents who are worried about problems with their children's development that could be linked to persistent hearing loss, confirmed by testing, should ask for early referral to an ENT specialist.

Problems to look out for:

• Communications and behaviour problems.

• Repeated ear infections.

• Exposure to smoking at home.

• Family history of ear infections and glue ear.

A copy of the leaflet Glue Ear is available from the Defeating Deafness Information Service. Please write, marking the envelope 'Glue Ear' and enclosing a large SAE (with stamps worth 33p) to Defeating Deafness FREEPOST, London WC4 938 or visit www.defeatingdeafness.org.